How do we manage our internet-informed patients?

Your patient comes in saying he has done his "research," and you want to cringe. Yet like it or not, Dr. Google is here to stay. How can you manage the doctor patient relationship in the Information Age? The first thing to know is you shouldn't discount the patient's effort. Read why here.

The technological and informational revolutionshave brought with them a slew of new advancements in the field of dentistry, many of which I have written about in previous articles and continue to use in my own practice. These new technologies have streamlined our workflows, provided new avenues for superior dental care, and, supplied many patients with a sense of safety, rooted in the knowledge that they are receiving cutting-edge treatment.

This growing association between the feeling of security and modern technology—particularly the internet—presents a unique problem, however, and one that routinely impacts the normal relationship between us and our patients: self-diagnosis.

We have all experienced the patient who arrives at our office armed to the teeth with printouts and factoids from websites like Google, WebMD, and other medical forums. At best, the information provided by these sources can offer quick insights that allow us to understand the specific symptoms that the patient is feeling. At worst, these sites can act as echo chambers, worsening the uncertainties of these patients while providing equal doses of worst-case scenarios, veiled advertisements for specific products, or even outright misinformation.

A medical colleague, Lester Gottesman, MD, shared some valuable insights with me when discussing the subject. His advice is that one shouldn’t discount the search, as the patient will feel hurt and insulted. The same forces that connect a patient’s feeling of comfort to our modern dental techniques are at the core of this self-diagnosis, and this makes our reactions incredibly important to their senses of safety, trust, and validity. Because of this, it is increasingly vital that we handle self-diagnosis in a positive way, approaching each facet of the issue to better treat our patients, retain our medical authority, and ensure that they are both comfortable and well informed.

Acknowledging the effort

Patients who come to us with extensive prior research have put a great deal of time into their self-diagnosis, and that effort should be properly acknowledged. Before any further discussion, be sure to reaffirm that the patient’s time was spent positively. For example, saying something like “It’s great that you have taken the time to understand your own health and treatment options,” recognizes his or her hard work. This ensures that the patient is validated, opening up a positive conversation about his or her symptoms.

This acknowledgment is fundamental to maintaining a positive doctor-patient relationship, but is also useful in maintaining workflow. Patients who are met with immediate skepticism may recoil, doubling down on their findings and making it more difficult to properly diagnose and explain their symptoms. This can drain valuable time from other patients, making validation a better option from both a cooperative and business perspective.

Focusing on the symptoms

Once the patient’s efforts have been recognized, it becomes necessary to boil down the often-extensive research into its most essential parts: the patient’s symptoms. These are usually hidden behind the online diagnoses, which many patients may be more eager to discuss. If this is the case, ask reaffirming questions such as, “What symptoms did you use for these searches?” in addition to the typical “What are you feeling?” This can help reaffirm that they weren’t wrong to be concerned with their own health care while informing you of the potential problem.

Maintaining authority

Our medical advice comes from years of education, training, and application, allowing us to properly diagnose and treat our patients as medical professionals. Once the symptoms have been separated from the surplus of information, it is important to inform the patient of your own conclusion, saying politely that it may be different from his or her online sources. It is during this step that some patients might “rubber band” back to their research, convinced that their symptoms could be something else.

As dentists, it is important that we maintain our authority as medical professionals. In cases of self-diagnosis, most of which come from an overreliance on internet-sourced information, this means reinforcing our position as the final arbiter of dental knowledge. This is best done politely and informatively. Fulfill the patient’s need for information and safety. Explain how you came to your diagnosis, why your proposed solution is the best option, and, if necessary, why the other conclusions do not apply to this particular case. This allows us to provide the proper treatment while building trust, informing our patients, and maintaining our authority.

Guiding future self-diagnosis

It may be impossible to prevent self-diagnosis in certain patients. Outright advising against it can even damage doctor-patient relationships, making it difficult to provide proper care. Instead, try informing the patient how to best guide his or her research rather than forbidding it. Putting an emphasis on well-sourced articles, .gov domain names, or even specific sources that you trust can help exclude misleading information. Warn them about tailored advertising and how it often masquerades as informative articles. Teach them to focus on their symptoms rather than on a full diagnosis, a tactic that can allow them to better inform you during subsequent visits.

Conclusion

Approaching self-diagnosis can be a difficult, even frustrating, task for any dentist. But for our patients, this research can be a manifestation of their significant health-care anxieties. It is in their best interest—as well as the interests of our practices—that we open this line of communication rather than close it, providing a caring place that can inform and treat these patients.

Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.